曲美他嗪治療穩定型心絞痛療效與安全性的系統評價_《中國循證醫學雜志》

作者：

賀春暉 ¹ ,  馬依彤 ¹ , 蘇冉 ² , 于子翔 ¹ , 王曉軍 ³

1. 新疆醫科大學第一附屬醫院心臟病中心冠心病一科（烏魯木齊 830054）；2. 新疆醫科大學第一附屬醫院風濕免疫科（烏魯木齊 830054）；3. 承德市中心醫院內分泌科（承德 067000）;

關鍵詞：

曲美他嗪穩定型心絞痛 Meta分析系統評價隨機對照試驗

DOI：

10.7507/1672-2531.20120114

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目的系統評價曲美他嗪（Trimetazidine，TMZ）治療穩定型心絞痛（stable angina pectoris，SAP）的臨床療效和安全性。
方法計算機檢索CBM（1989～2011.6）、CNKI（1997～2011.6）、WanFang Data（1989～2011.6）、MEDLINE（1966～2011.6）、EMbase（1974～2011.6）和Cochrane對照試驗資料庫（1989～2011.6）中有關曲美他嗪治療穩定型心絞痛的隨機對照試驗（RCT），按納入與排除標準選擇文獻并進行資料提取和質量評價后，采用RevMan 5.0軟件進行Meta分析。
結果共納入15個RCT，1 500例患者。Meta分析結果顯示：在平板/踏車試驗ST段壓低1 mm閾值［WMD=0.84，95%（0.74，0.93），P lt;0.000 01］、運動持續時間［WMD=0.82，95%（0.73，0.91），P lt;0.000 01］、心絞痛發作閾值［WMD=1.18，95%（0.87，1.50），P lt;0.000 01］、每周心絞痛發作次數［WMD=–1.79，95%（–1.93，–1.66），P lt;0.000 01］和每周硝酸甘油消耗量［WMD=–0.60，95%（–0.74，–0.46），P lt;0.000 01]五個方面，曲美他嗪組均明顯優于對照組；而在副反應方面，曲美他嗪組與對照組的差異無統計學意義［RR=0.83，95%CI（0.52，1.32），P=0.42］。
結論曲美他嗪治療穩定型心絞痛療效優于對照藥物，而副反應與對照藥物無明顯差別，療效確切，安全性較好。受納入文獻的質量限制及可能存在的發表偏倚影響，本Meta分析結論尚需開展更多高質量、大樣本、多中心、隨機雙盲對照試驗加以證實。

引用本文： 賀春暉 ,馬依彤,蘇冉,于子翔,王曉軍. 曲美他嗪治療穩定型心絞痛療效與安全性的系統評價. 中國循證醫學雜志, 2012, 12(6): 700-707. doi: 10.7507/1672-2531.20120114 復制

1.	Kantor P F, Lucien A, Kozak R, et al. The antianginal drug trimetazidine shifts cardiac energy metabolism from fatty acid oxidation to glucose oxidation by inhibiting mitochondrial long chain 3 ketoacyl coenzyme a thiolase. Circ Res, 2000, 86: 580-588.
2.	Mc Clelian KJ, Plosker GL. Trimetazidine: A review of itsuse in stable angina pectoris and other coronary condition. Drugs, 1999, 58(1): 143-157.
3.	Desideri A, Celegon L. Metabolic management of ischemic heart disease: clinical data with trimetazidine. Am J Cardiol, 1998, 82(5): 50-53.
4.	Cross H R.Trimetazidine for stable angina pectoris. Expert Opin Pharmacother, 2001, (5): 857-875.
5.	Austen WG, Edwards JE, Frye RL, et al. A reporting system on patients evaluated for coronary artery disease. Report of the Ad Hoc Committee for Grading of Coronary Artery Disease, Council on Cardiovascular Surgery, American Heart Association. Circulation, 1975, 51(4Suppl): 5-40.
6.	Jadad AR, Moore RA, Corral D. Assessing the qaulity of the reports of randomized clinical trials :is blinding necessary? Control Clin Trials, 1996, 17(1): 1-12.
7.	Sergio DV, Giuseppe M, Patricia DV, et al. Comparison of Trimetazidine with Nifedipine in Effort Angina:A Double-Blind, Crossover Study. Cardiovascular Drugs and Therapy, 1990, 4: 853-860.
8.	Andreas PM, Konstantinos S, Konstantinos D, et al. Antianginal Efficacy of the Combination of Trimetazidine-Propranolol Compared with Isosorbide Dinatrate-Propranolol in Patients with Stable Angina. Clin Drug Invest, 1997, 1, 13(1): 8-14.
9.	Philippe S, Jean PB. Assessment of Anti-Ischemic and Antianginal Effect at Trough Plasma Concentration and Safety of Trimetazidine MR 35mg in Patients with Stable Angina Pectoris, A multicenter, double blind, placebo controlled study. Am J Cardiovasc Drugs, 2003, 3(5): 361-369.
10.	許嘉鴻, 羅明, 鄧兵, 等. 曲美他嗪治療穩定型心絞痛的療效和耐受性. 同濟大學學報（醫學版）, 2003, 24(6): 492-493.
11.	Nevres K, Ahmet K B, Kamil A, et al. Comparison of the effects of trimetazidine and diltiazem on exercise performance in patients with coronary heart disease. The Turkish trimetazidine study (TTS). Acta Cardiol, 2004, 12; 59(6): 644-650.
12.	Ruzyllo W, Szwed H, Sadowski Z, et al. Efficacy of trimetazidine in patients with recurrent angina: a subgroup analysis of the TRIMPOL II study. Current Medical Research and Opinion, 2004, 20(9): 1447-1454.
13.	Hanna S. Clinical benefits of trimetazidine in patients with recurrent angina. Coronary Artery Disease, 2004, 15 (S1): S17-21.
14.	童延清, 李暉. 曲美他嗪治療穩定型心絞痛的臨床研究. 心肺血管病雜志, 2004, 23(1):40.
15.	鄭育平, 謝彤. 曲美他嗪治療慢性腎衰竭合并冠心病穩定型心絞痛的臨床療效. 中國藥師, 2004, 7(5): 371-372.
16.	Chazov EI, Lepakchin VK, Zharova EA, et al. Trimetazidine in Angina Combination Therapy-The TACT Study:Trimetazidine versus Conventional Treatment in Patients with Stable Angina Pectoris in a Randomized, Placebo-Controlled, Multicenter Study. American Journal of Therapeutics, 2005, 12(1): 35-42.
17.	周英, 李艷. 曲美他嗪在老年穩定性心絞痛中的作用.吉林醫學, 2005, 26(10): 1061-1062.
18.	龐紅, 林華, 張金枝. 曲美他嗪治療穩定型勞力性心絞痛的對照觀察.中國醫院藥學雜志, 2005, 25(12): 1158-1159.
19.	王伯忠, 王雁. 曲美他嗪與輔酶Q10治療老年慢性穩定型心絞痛的臨床觀察.心腦血管病防治, 2006, 6(2): 103-105.
20.	張剛, 曹雪濱, 崔英凱,等. 曲美他嗪和倍他樂克聯合應用治療穩定型心絞痛的臨床研究.現代中西醫結合雜志, 2006, 15(21): 2926-2927.
21.	鄭云. 曲美他嗪治療穩定型心絞痛50例療效觀察. 臨床醫學, 2010, 23(6): 1858-1859.

1. Kantor P F, Lucien A, Kozak R, et al. The antianginal drug trimetazidine shifts cardiac energy metabolism from fatty acid oxidation to glucose oxidation by inhibiting mitochondrial long chain 3 ketoacyl coenzyme a thiolase. Circ Res, 2000, 86: 580-588.
2. Mc Clelian KJ, Plosker GL. Trimetazidine: A review of itsuse in stable angina pectoris and other coronary condition. Drugs, 1999, 58(1): 143-157.
3. Desideri A, Celegon L. Metabolic management of ischemic heart disease: clinical data with trimetazidine. Am J Cardiol, 1998, 82(5): 50-53.
4. Cross H R.Trimetazidine for stable angina pectoris. Expert Opin Pharmacother, 2001, (5): 857-875.
5. Austen WG, Edwards JE, Frye RL, et al. A reporting system on patients evaluated for coronary artery disease. Report of the Ad Hoc Committee for Grading of Coronary Artery Disease, Council on Cardiovascular Surgery, American Heart Association. Circulation, 1975, 51(4Suppl): 5-40.
6. Jadad AR, Moore RA, Corral D. Assessing the qaulity of the reports of randomized clinical trials :is blinding necessary? Control Clin Trials, 1996, 17(1): 1-12.
7. Sergio DV, Giuseppe M, Patricia DV, et al. Comparison of Trimetazidine with Nifedipine in Effort Angina:A Double-Blind, Crossover Study. Cardiovascular Drugs and Therapy, 1990, 4: 853-860.
8. Andreas PM, Konstantinos S, Konstantinos D, et al. Antianginal Efficacy of the Combination of Trimetazidine-Propranolol Compared with Isosorbide Dinatrate-Propranolol in Patients with Stable Angina. Clin Drug Invest, 1997, 1, 13(1): 8-14.
9. Philippe S, Jean PB. Assessment of Anti-Ischemic and Antianginal Effect at Trough Plasma Concentration and Safety of Trimetazidine MR 35mg in Patients with Stable Angina Pectoris, A multicenter, double blind, placebo controlled study. Am J Cardiovasc Drugs, 2003, 3(5): 361-369.
10. 許嘉鴻, 羅明, 鄧兵, 等. 曲美他嗪治療穩定型心絞痛的療效和耐受性. 同濟大學學報（醫學版）, 2003, 24(6): 492-493.
11. Nevres K, Ahmet K B, Kamil A, et al. Comparison of the effects of trimetazidine and diltiazem on exercise performance in patients with coronary heart disease. The Turkish trimetazidine study (TTS). Acta Cardiol, 2004, 12; 59(6): 644-650.
12. Ruzyllo W, Szwed H, Sadowski Z, et al. Efficacy of trimetazidine in patients with recurrent angina: a subgroup analysis of the TRIMPOL II study. Current Medical Research and Opinion, 2004, 20(9): 1447-1454.
13. Hanna S. Clinical benefits of trimetazidine in patients with recurrent angina. Coronary Artery Disease, 2004, 15 (S1): S17-21.
14. 童延清, 李暉. 曲美他嗪治療穩定型心絞痛的臨床研究. 心肺血管病雜志, 2004, 23(1):40.
15. 鄭育平, 謝彤. 曲美他嗪治療慢性腎衰竭合并冠心病穩定型心絞痛的臨床療效. 中國藥師, 2004, 7(5): 371-372.
16. Chazov EI, Lepakchin VK, Zharova EA, et al. Trimetazidine in Angina Combination Therapy-The TACT Study:Trimetazidine versus Conventional Treatment in Patients with Stable Angina Pectoris in a Randomized, Placebo-Controlled, Multicenter Study. American Journal of Therapeutics, 2005, 12(1): 35-42.
17. 周英, 李艷. 曲美他嗪在老年穩定性心絞痛中的作用.吉林醫學, 2005, 26(10): 1061-1062.
18. 龐紅, 林華, 張金枝. 曲美他嗪治療穩定型勞力性心絞痛的對照觀察.中國醫院藥學雜志, 2005, 25(12): 1158-1159.
19. 王伯忠, 王雁. 曲美他嗪與輔酶Q10治療老年慢性穩定型心絞痛的臨床觀察.心腦血管病防治, 2006, 6(2): 103-105.
20. 張剛, 曹雪濱, 崔英凱,等. 曲美他嗪和倍他樂克聯合應用治療穩定型心絞痛的臨床研究.現代中西醫結合雜志, 2006, 15(21): 2926-2927.
21. 鄭云. 曲美他嗪治療穩定型心絞痛50例療效觀察. 臨床醫學, 2010, 23(6): 1858-1859.

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《中國循證醫學雜志》

曲美他嗪治療穩定型心絞痛療效與安全性的系統評價

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